Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge: A Meta-analysis

Nivedita R. Potapragada, Elnur Babayev, Danielle Strom, Molly Beestrum, Jacob M. Schauer, Emily S. Jungheim*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

OBJECTIVE:To assess the odds of pregnancy after intrauterine insemination (IUI) timed by ultrasound monitoring and human chorionic gonadotropin (hCG) administration compared with monitoring luteinizing hormone (LH) levels.DATA SOURCES:We searched PubMed (MEDLINE), EMBASE (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), ClinicalTrials.gov (National Institutes of Health), and the Cochrane Library (Wiley) from the inception until October 1, 2022. No language limitations were applied.METHODS OF STUDY SELECTION:After deduplication, 3,607 unique citations were subjected to blinded independent review by three investigators. Thirteen studies (five retrospective cohort, four cross-sectional, two randomized controlled trials, and two randomized crossover studies) that enrolled women undergoing natural cycle, oral medication (clomid or letrozole), or both for IUI were included in the final random-effects model meta-analysis. Methodologic quality of included studies was assessed with the Downs and Black checklist.TABULATION, INTEGRATION, AND RESULTS:Data extraction was compiled by two authors, including publication information, hCG and LH monitoring guidelines, and pregnancy outcomes. No significant difference in odds of pregnancy between hCG administration and endogenous LH monitoring was observed (odds ratio [OR] 0.92, 95% CI 0.69-1.22, P=.53). Subgroup analysis of the five studies that included natural cycle IUI outcomes also showed no significant difference in odds of pregnancy between the two methods (OR 0.88, 95% CI 0.46-1.69, P=.61). Finally, a subgroup analysis of 10 studies that included women who underwent ovarian stimulation with oral medications (clomid or letrozole) did not demonstrate a difference in odds of pregnancy between ultrasonography with hCG trigger and LH-timed IUI (OR 0.88, 95% CI 0.66-1.16, P=.32). Statistically significant heterogeneity was noted between studies.CONCLUSION:This meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42021230520.

Original languageEnglish (US)
Pages (from-to)61-70
Number of pages10
JournalObstetrics and gynecology
Volume142
Issue number1
DOIs
StatePublished - Jul 1 2023

Funding

This work was supported by the internal funds of the Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University.

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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